Colorectal cancer is a leading cause of cancer-related deaths in the United States. More than 90% of colon cancers develop from adenomatous polyps, removal of which can dramatically reduce the risk of death. Accepted guidelines recommend the screening of adults who are at average risk for colorectal cancer, since the detection and removal of adenomas has been shown to reduce the incidence of cancer and cancer-related mortality. Currently available detection methods include fecal occult blood tests, sigmoidoscopy, barium enemas, and fiber optic colonoscopies (OC). Unfortunately, most people do not follow this advice because of the discomfort and inconvenience of the traditional optical colonoscopy. To encourage people to participate in screening programs, virtual colonoscopy (VC), also known as computed tomographic colonography (CTC), has been proposed and developed to detect colorectal neoplasms by using a computed tomography (CT) or magnetic resonance imaging (MRI) scan. VC is minimally invasive and does not require sedation or the insertion of a colonoscope. Compared to OC, VC has the potential to become a common screening method in terms of safety, cost, and patient compliance. VC exploits computers to reconstruct a 3D model of the CT scans taken of the patient's abdomen, and creates a virtual fly-through of the colon to help radiologists navigate the model and create an accurate, efficient diagnosis. Previously known systems and methods for performing virtual colonoscopy are described, for example, in U.S. Pat. Nos. 5,971,767, 6,331,116 and 6,514,082, the disclosures of which are incorporated by reference in their entireties.
It has been demonstrated that the performance of VC can compare favorably with that of traditional OC. As is required with traditional optical colonoscopies, the colon needs a thorough cleansing before the VC and computer aided detection (CAD) of polyps. However, even with a rigorous cleansing of the colon, remaining stool and fluid residues may mimic polyps, thereby dramatically reducing the efficiency of the VC and CAD.
Electronic colon cleansing (ECC) may be used to improve the efficiency of VC and CAD by effectively removing colonic material from the acquired images. Preparing the colon for ECC varies slightly from traditional VC and CAD without ECC. A preliminary step of ECC is tagging the colonic material with a contrast agent. With the addition of a contrast agent, the tagged stool and fluid have an enhanced image density compared to the density of the colon/polyp tissues. By segmenting the colon images and recognizing patterns, ECC methods can be used to identify the enhanced colonic material and produce a “clean” colon model for both VC navigation and CAD analysis. A known ECC approach is to apply simple thresholds to the image data for segmentation and then removing certain tagged material. However, the effectiveness of the threshold approach to ECC may be impaired by a partial volume (PV) effect at various boundary regions, such as the air-colonic material interface and the colon/polyp tissue-colonic material interface.
Various approaches to mitigate the PV effect have been explored in the art. For example, a ray-based detection technique exists, which utilizes a predefined profiled pattern to detect interfaces. Other techniques use morphological and linear filters, image gradient information, and a priori models to mitigate the PV effect. Each of the previous methods relies on the assumption that limited information may be derived from an image voxel, which limits the effectiveness of the solution. As a result, improved techniques for addressing the PV effect are desired. An improvement is particularly important in CAD of polyps because the mucosa region of the colon, in which polyps often reside, is a boundary region which is often obscured by the PV effect. Thus, it is an object of the present method to provide an improved electronic cleansing process and, in particular, to provide an electronic cleansing process which results in a clean mucosa layer well-suited for CAD techniques.